Rapidly Adapting a Multicomponent Treatment for Persons Experiencing Chronic Homelessness with Comorbid Substance Use and Mental Health Disorders During the Coronavirus Disease 2019 Pandemic
Main Article Content
Abstract
Background: People with co-occurring substance use and mental health disorders (COD) who experience chronic homelessness often have difficulty engaging in treatment and support services. During the Coronavirus Disease 2019 (COVID-19) pandemic this problem was compounded by community agencies reducing or eliminating in-person care to minimize transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examined the rapid adaptations that were made during COVID-19 to a community-based multicomponent intervention, Maintaining Independence and Sobriety Thorough Systems Integration, Outreach and Networking (MISSION), and how these changes impacted engagement in treatment and fidelity to the intervention prior to and during the COVID-19 pandemic.
Methods: Guided by the Model for Adaptation Design and Impact (MADI) framework, this mixed-methods study (1) qualitatively examines the nature of the rapid adaptations made to the MISSION model with n=4 MISSION clinical program staff and (2) quantitatively examines patterns of engagement and fidelity to the MISSION model prior to and during the pandemic among n=109 people with COD who are experiencing chronic homelessness in an urban region of Massachusetts.
Results: In consultation with the MISSION developers, clinical staff made rapid innovative adaptations to MISSION. These changes, identified through the qualitative interviews, included developing safe in-person session procedures (e.g., shortening sessions, adapting group sessions to individual sessions) and strategies to engage incarcerated individuals to provide continuity of care (e.g., mailing letters and coordinating with jail staff). Despite the adaptations, adherence to the MISSION model remained consistent during COVID-19 and compared to pre-COVID-19. However, there was more adherence to the structured components of care compared to the unstructured components of care during the pandemic. Interestingly, linkages to other needed treatments and community supports increased by 522% despite the pandemic closures.
Conclusions: This mixed-methods study demonstrated that a community-based multicomponent intervention for people experiencing chronic homelessness with COD can be adapted rapidly during a pandemic to help maintain COD treatment and with good fidelity, and that the MADI framework can help document those changes. Thus, these findings provide treatment settings with helpful guidance for community-based COD interventions and public health emergency preparedness.
Keywords:
COVID-19, mental health, addiction, substance use disorders, co-occurring disorders, homeless, pandemic, pandemic preparedness, public health response, wraparound interventions
Article Details
How to Cite
SHAFFER, Paige M. et al.
Rapidly Adapting a Multicomponent Treatment for Persons Experiencing Chronic Homelessness with Comorbid Substance Use and Mental Health Disorders During the Coronavirus Disease 2019 Pandemic.
Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4507>. Date accessed: 23 nov. 2024.
doi: https://doi.org/10.18103/mra.v11i11.4507.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Pfefferbaum B, North CS. Mental Health and the Covid-19 Pandemic. N Engl J Med. Aug 6 2020;383(6):510-512. doi:10.1056/NEJMp2008017.
2. Apr 2020;5(4):e186-e187. doi:10.1016/S2468-2667(20)30053-0
3. Drake RE, Osher FC, Wallach MA. Homelessness and dual diagnosis. Am Psychol. Nov 1991;46(11):1149-58. doi:10.1037//0003-066x.46.11.1149
4. Prigerson HG, Desai RA, Liu-Mares W, Rosenheck RA. Suicidal ideation and suicide attempts in homeless mentally ill persons: age-specific risks of substance abuse. Soc Psychiatry Psychiatr Epidemiol. Apr 2003;38(4):213-9. doi:10.1007/s00127-003-0621-8
5. Chloe E Bird KJJ, M Audrey Burnam, Paul Koegel, Greer Sullivan, Suzanne L Wenzel, M Susan Ridgely, Sally C Morton, Angela Miu. Predictors of contact with public service sectors among homeless adults with and without alcohol and other drug disorders. Journal of Studies on Alcohol. 2002;63(6):716-726. doi:10.15288/jsa.2002.63.716.
6. Tsemberis S, Gulcur L, Nakae M. Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health. Apr 2004;94(4):651-6. doi:10.2105/ajph.94.4.651
7. Polcin DL. Co-occurring Substance Abuse and Mental Health Problems among Homeless Persons: Suggestions for Research and Practice. J Soc Distress Homeless. 2016;25(1):1-10. doi:10.1179/1573658X15Y.0000000004
8. Lawrence D, Kisely S. Inequalities in healthcare provision for people with severe mental illness. J Psychopharmacol. Nov 2010;24(4 Suppl):61-8. doi:10.1177/1359786810382058
9. Nair S, Kannan P, Mehta K, Raju A, Mathew J, Ramachandran P. The COVID-19 pandemic and its impact on mental health services: the provider perspective. J Public Health (Oxf). Oct 8 2021;43(Supplement_2):ii51-ii56. doi:10.1093/pubmed/fdab163
10. Fryling LR, Mazanec P, Rodriguez RM. Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act. J Emerg Med. Nov 2015;49(5):755-62 e2. doi:10.1016/j.jemermed.2015.06.005
11. Humphry J. The Importance of Circumstance: digital access and affordability for people experiencing homelessness. Australian Journal of Telecommunications and the Digital Economy. 10/01 2014;Volume 2doi:10.7790/ajtde.v2n3.55
12. Humphry J. Homelessness and Mobile Communication: Precariously Connected. Springer Nature Singapore; 2022.
13. Davidson L, White W. The concept of recovery as an organizing principle for integrating mental health and addiction services. J Behav Health Serv Res. Apr 2007;34(2):109-20. doi:10.1007/s11414-007-9053-7
14. Clark HW, Power AK, Le Fauve CE, Lopez EI. Policy and practice implications of epidemiological surveys on co-occurring mental and substance use disorders. J Subst Abuse Treat. Jan 2008;34(1):3-13. doi:10.1016/j.jsat.2006.12.032
15. Treatment CfSA. Substance Abuse Treatment For Persons With Co-Occurring Disorders: A Treatment Improvement Protocol (TIP 42). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2005.
16. Pinals DA, Gaba A, Clary KM, Barber J, Reiss J, Smelson D. Implementation of MISSION-Criminal Justice in a Treatment Court: Preliminary Outcomes Among Individuals With Co-occurring Disorders. Psychiatr Serv. Nov 1 2019;70(11):1044-1048. doi:10.1176/appi.ps.201800570
17. Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION). [online]: SAMHSA’s National Registry of Evidence-based Programs and Practices.
18. Drake RE, Bond, G. R., & Becker, D. R. Individual placement and support: an evidence- based approach to supported employment. Oxford University Press. 2012;
19. O'Connor K, Kline, A., Sawh, L., Rodrigues, S., Fisher, W., Kane, V., Kuhn, J., Ellison, M., & Smelson, D. Unemployment and co-occurring disorders among homeless veterans. Journal of Dual Diagnosis. 2013;9(2):134-138. doi:https://doi.org/10.1080/15504263.2013.778804
20. Miller NA, Najavits LM. Creating trauma-informed correctional care: a balance of goals and environment. Eur J Psychotraumatol. 2012;3doi:10.3402/ejpt.v3i0.17246
21. SAMHSA. Opioid Data Analysis and Resources. https://www.cdc.gov/drugoverdose/data/analysis.html#anchor_data_analysis
22. Ziedonis DM, & Stern, R. Dual recovery therapy for schizophrenia and substance abuse. Psychiatric Annals. 2001;31(4):255-264.
23. Chinman M, Young AS, Hassell J, Davidson L. Toward the implementation of mental health consumer provider services. J Behav Health Serv Res. Apr 2006;33(2):176-95. doi:10.1007/s11414-006-9009-3
24. Klein AR, Cnaan, R. A., & Whitecraft, J. Significance of peer social support with dually diagnosed clients: Findings from a pilot study. Research on Social Work Practice. 1998;8(5):529-551.
25. Davison KP, Pennebaker JW, Dickerson SS. Who talks? The social psychology of illness support groups. Am Psychol. Feb 2000;55(2):205-17.
26. Wilson ME, Flanagan, S., & Rynders, C. The FRIENDS program: A peer support group model for individuals with a psychiatric disability. Psychiatric Rehabilitation Journal. 1999;22(3):239.
27. Yanos PT, Primavera LH, Knight EL. Consumer-run service participation, recovery of social functioning, and the mediating role of psychological factors. Psychiatr Serv. Apr 2001;52(4):493-500. doi:10.1176/appi.ps.52.4.493
28. Wiltsey Stirman S, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implement Sci. Jun 6 2019;14(1):58. doi:10.1186/s13012-019-0898-y
29. Kirk MA, Moore JE, Wiltsey Stirman S, Birken SA. Towards a comprehensive model for understanding adaptations' impact: the model for adaptation design and impact (MADI). Implement Sci. Jul 20 2020;15(1):56. doi:10.1186/s13012-020-01021-y
30. Leung FH, Savithiri R. Spotlight on focus groups. Can Fam Physician. Feb 2009;55(2):218-9.
31. Tanya de Sousa AA MC, Jhenelle Marson, Ed Prestera, and Katherine Rush, Abt Associates. . The 2022 Annual Homelessness Assessment Report (AHAR) to Congress In: The U.S. Department of Housing and Urban Development. 2022;(ed2022)
32. Susser E, Valencia E, Conover S, Felix A, Tsai WY, Wyatt RJ. Preventing recurrent homelessness among mentally ill men: a "critical time" intervention after discharge from a shelter. Am J Public Health. Feb 1997;87(2):256-62. doi:10.2105/ajph.87.2.256
33. Chinman M, George P, Dougherty RH, et al. Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatr Serv. Apr 1 2014;65(4):429-41. doi:10.1176/appi.ps.201300244
34. Chinman M, Shoai R, Cohen A. Using organizational change strategies to guide peer support technician implementation in the Veterans Administration. Psychiatr Rehabil J. Spring 2010;33(4):269-77. doi:10.2975/33.4.2010.269.277
35. Development HaU. Definition of Chronic Homelessness.
36. Eisen SV, Normand SL, Belanger AJ, Spiro A, 3rd, Esch D. The Revised Behavior and Symptom Identification Scale (BASIS-R): reliability and validity. Med Care. Dec 2004;42(12):1230-41. doi:10.1097/00005650-200412000-00010
37. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. Sep 18 2013;13:117. doi:10.1186/1471-2288-13-117
38. Bryant A, Charmaz K. The SAGE Handbook of Grounded Theory: Paperback Edition. SAGE Publications; 2010.
39. Sandelowski M. Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-method studies. Res Nurs Health. Jun 2000;23(3):246-55. doi:10.1002/1098-240x(200006)23:3<246::aid-nur9>3.0.co;2-h
40. Druss BG. Addressing the COVID-19 Pandemic in Populations With Serious Mental Illness. JAMA Psychiatry. Sep 1 2020;77(9):891-892. doi:10.1001/jamapsychiatry.2020.0894
41. Smith K, Ostinelli E, Macdonald O, Cipriani A. COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians. JMIR Ment Health. Aug 28 2020;7(8):e21108. doi:10.2196/21108
42. Maulik PK, Thornicroft G, Saxena S. Roadmap to strengthen global mental health systems to tackle the impact of the COVID-19 pandemic. Int J Ment Health Syst. 2020;14:57. doi:10.1186/s13033-020-00393-4
43. Han RH, Schmidt MN, Waits WM, Bell AKC, Miller TL. Planning for Mental Health Needs During COVID-19. Curr Psychiatry Rep. Oct 8 2020;22(12):66. doi:10.1007/s11920-020-01189-6
44. Jurcik T, Jarvis GE, Zeleskov Doric J, et al. Adapting mental health services to the COVID-19 pandemic: Reflections from professionals in four countries. Counselling Psychology Quarterly. 2021;34(3-4):649-675. doi:10.1080/09515070.2020.1785846
45. Pagano A, Hosakote S, Kapiteni K, Straus ER, Wong J, Guydish JR. Impacts of COVID-19 on residential treatment programs for substance use disorder. J Subst Abuse Treat. Apr 2021;123:108255. doi:10.1016/j.jsat.2020.108255
46. Clair K, Ijadi-Maghsoodi R, Nazinyan M, Gabrielian S, Kalofonos I. Veteran Perspectives on Adaptations to a VA Residential Rehabilitation Program for Substance Use Disorders During the Novel Coronavirus Pandemic. Community Ment Health J. Jul 2021;57(5):801-807. doi:10.1007/s10597-021-00810-z
47. Kim B, Petrakis BA, Sliwinski SK, McInnes DK, Gifford AL, Smelson DA. Staff and Veteran Perspectives on Residential Treatment Programs' Responses to COVID-19: A Qualitative Study Guided by the WHO's After Action Review Framework. Community Ment Health J. Apr 2023;59(3):600-608. doi:10.1007/s10597-022-01038-1
48. Guthrie-Gower S, Wilson-Menzfeld G. Ex-military personnel's experiences of loneliness and social isolation from discharge, through transition, to the present day. PLoS One. 2022;17(6):e0269678. doi:10.1371/journal.pone.0269678
49. Hystad P, Carpiano RM. Sense of community-belonging and health-behaviour change in Canada. J Epidemiol Community Health. Mar 2012;66(3):277-83. doi:10.1136/jech.2009.103556
50. Best D, Irving J, Collinson B, Andersson C, Edwards M. Recovery Networks and Community Connections: Identifying Connection Needs and Community Linkage Opportunities in Early Recovery Populations. Alcoholism Treatment Quarterly. 12/27 2016;35:1-14. doi:10.1080/07347324.2016.1256718
51. Best D, Musgrove A, Hall L. The bridge between social identity and community capital on the path to recovery and desistance. Probation Journal. 2018;65(4):394-406. doi:10.1177/0264550518790677
52. Tucker JS, D'Amico EJ, Pedersen ER, Garvey R, Rodriguez A, Klein DJ. Behavioral Health and Service Usage During the COVID-19 Pandemic Among Emerging Adults Currently or Recently Experiencing Homelessness. J Adolesc Health. Oct 2020;67(4):603-605. doi:10.1016/j.jadohealth.2020.07.013
53. Dunlop A, Lokuge B, Masters D, et al. Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic. Harm Reduct J. May 6 2020;17(1):26. doi:10.1186/s12954-020-00370-7
54. Aragona M, Barbato A, Cavani A, Costanzo G, Mirisola C. Negative impacts of COVID-19 lockdown on mental health service access and follow-up adherence for immigrants and individuals in socio-economic difficulties. Public Health. Sep 2020;186:52-56. doi:10.1016/j.puhe.2020.06.055
55. Cawley C, Kanzaria HK, Zevin B, Doran KM, Kushel M, Raven MC. Mortality Among People Experiencing Homelessness in San Francisco During the COVID-19 Pandemic. JAMA Netw Open. Mar 1 2022;5(3):e221870. doi:10.1001/jamanetworkopen.2022.1870
56. Conway B, Truong D, Wuerth K. COVID-19 in homeless populations: Unique challenges and opportunities. Future Virology. 06/26 2020;15doi:10.2217/fvl-2020-0156
57. Ahmed F, Ahmed N, Pissarides C, Stiglitz J. Why inequality could spread COVID-19. Lancet Public Health. May 2020;5(5):e240. doi:10.1016/s2468-2667(20)30085-2
58. Pirisi A. Low health literacy prevents equal access to care. Lancet. Nov 25 2000;356(9244):1828. doi:10.1016/s0140-6736(05)73297-9
59. Douglas PK, Douglas DB, Harrigan DC, Douglas KM. Preparing for pandemic influenza and its aftermath: mental health issues considered. Int J Emerg Ment Health. Summer 2009;11(3):137-44.
60. Huremović D. Psychiatry of pandemics: A mental health response to infection outbreak (Ed.). Springer International Publishing. 2019;doi:https://doi.org/10.1007/978-3-030-15346-5
61. Zhou X, Snoswell CL, Harding LE, et al. The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemed J E Health. Apr 2020;26(4):377-379. doi:10.1089/tmj.2020.0068
62. Bureau USC. QuickFacts, Springfield City, Massachusetts. https://www.census.gov/quickfacts/fact/table/springfieldcitymassachusetts/PST045222
63. Centers for Disease Control and Prevention/ Agency for Toxic Substances and Disease Registry/ Geospatial Research A, and Services Program. CDC/ATSDR Social Vulnerability Index Database Massachusetts. https://www.atsdr.cdc.gov/placeandhealth/svi/data_documentation_download.html
64. Padgett DK, Henwood B, Abrams C, Davis A. Engagement and retention in services among formerly homeless adults with co-occurring mental illness and substance abuse: voices from the margins. Psychiatr Rehabil J. Winter 2008;31(3):226-33. doi:10.2975/31.3.2008.226.233
65. Horsfall J, Cleary M, Hunt GE, Walter G. Psychosocial treatments for people with co-occurring severe mental illnesses and substance use disorders (dual diagnosis): a review of empirical evidence. Harv Rev Psychiatry. 2009;17(1):24-34. doi:10.1080/10673220902724599
66. Nunez A, Sreeganga SD, Ramaprasad A. Access to Healthcare during COVID-19. Int J Environ Res Public Health. Mar 14 2021;18(6)doi:10.3390/ijerph18062980
67. Chen KL, Brozen M, Rollman JE, et al. How is the COVID-19 pandemic shaping transportation access to health care? Transp Res Interdiscip Perspect. Jun 2021;10:100338. doi:10.1016/j.trip.2021.100338
68. Byrne A, Barber R, Lim C. Impact of the COVID‐19 pandemic – a mental health service perspective. Progress in Neurology and Psychiatry. 2021;25
2. Apr 2020;5(4):e186-e187. doi:10.1016/S2468-2667(20)30053-0
3. Drake RE, Osher FC, Wallach MA. Homelessness and dual diagnosis. Am Psychol. Nov 1991;46(11):1149-58. doi:10.1037//0003-066x.46.11.1149
4. Prigerson HG, Desai RA, Liu-Mares W, Rosenheck RA. Suicidal ideation and suicide attempts in homeless mentally ill persons: age-specific risks of substance abuse. Soc Psychiatry Psychiatr Epidemiol. Apr 2003;38(4):213-9. doi:10.1007/s00127-003-0621-8
5. Chloe E Bird KJJ, M Audrey Burnam, Paul Koegel, Greer Sullivan, Suzanne L Wenzel, M Susan Ridgely, Sally C Morton, Angela Miu. Predictors of contact with public service sectors among homeless adults with and without alcohol and other drug disorders. Journal of Studies on Alcohol. 2002;63(6):716-726. doi:10.15288/jsa.2002.63.716.
6. Tsemberis S, Gulcur L, Nakae M. Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health. Apr 2004;94(4):651-6. doi:10.2105/ajph.94.4.651
7. Polcin DL. Co-occurring Substance Abuse and Mental Health Problems among Homeless Persons: Suggestions for Research and Practice. J Soc Distress Homeless. 2016;25(1):1-10. doi:10.1179/1573658X15Y.0000000004
8. Lawrence D, Kisely S. Inequalities in healthcare provision for people with severe mental illness. J Psychopharmacol. Nov 2010;24(4 Suppl):61-8. doi:10.1177/1359786810382058
9. Nair S, Kannan P, Mehta K, Raju A, Mathew J, Ramachandran P. The COVID-19 pandemic and its impact on mental health services: the provider perspective. J Public Health (Oxf). Oct 8 2021;43(Supplement_2):ii51-ii56. doi:10.1093/pubmed/fdab163
10. Fryling LR, Mazanec P, Rodriguez RM. Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act. J Emerg Med. Nov 2015;49(5):755-62 e2. doi:10.1016/j.jemermed.2015.06.005
11. Humphry J. The Importance of Circumstance: digital access and affordability for people experiencing homelessness. Australian Journal of Telecommunications and the Digital Economy. 10/01 2014;Volume 2doi:10.7790/ajtde.v2n3.55
12. Humphry J. Homelessness and Mobile Communication: Precariously Connected. Springer Nature Singapore; 2022.
13. Davidson L, White W. The concept of recovery as an organizing principle for integrating mental health and addiction services. J Behav Health Serv Res. Apr 2007;34(2):109-20. doi:10.1007/s11414-007-9053-7
14. Clark HW, Power AK, Le Fauve CE, Lopez EI. Policy and practice implications of epidemiological surveys on co-occurring mental and substance use disorders. J Subst Abuse Treat. Jan 2008;34(1):3-13. doi:10.1016/j.jsat.2006.12.032
15. Treatment CfSA. Substance Abuse Treatment For Persons With Co-Occurring Disorders: A Treatment Improvement Protocol (TIP 42). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2005.
16. Pinals DA, Gaba A, Clary KM, Barber J, Reiss J, Smelson D. Implementation of MISSION-Criminal Justice in a Treatment Court: Preliminary Outcomes Among Individuals With Co-occurring Disorders. Psychiatr Serv. Nov 1 2019;70(11):1044-1048. doi:10.1176/appi.ps.201800570
17. Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION). [online]: SAMHSA’s National Registry of Evidence-based Programs and Practices.
18. Drake RE, Bond, G. R., & Becker, D. R. Individual placement and support: an evidence- based approach to supported employment. Oxford University Press. 2012;
19. O'Connor K, Kline, A., Sawh, L., Rodrigues, S., Fisher, W., Kane, V., Kuhn, J., Ellison, M., & Smelson, D. Unemployment and co-occurring disorders among homeless veterans. Journal of Dual Diagnosis. 2013;9(2):134-138. doi:https://doi.org/10.1080/15504263.2013.778804
20. Miller NA, Najavits LM. Creating trauma-informed correctional care: a balance of goals and environment. Eur J Psychotraumatol. 2012;3doi:10.3402/ejpt.v3i0.17246
21. SAMHSA. Opioid Data Analysis and Resources. https://www.cdc.gov/drugoverdose/data/analysis.html#anchor_data_analysis
22. Ziedonis DM, & Stern, R. Dual recovery therapy for schizophrenia and substance abuse. Psychiatric Annals. 2001;31(4):255-264.
23. Chinman M, Young AS, Hassell J, Davidson L. Toward the implementation of mental health consumer provider services. J Behav Health Serv Res. Apr 2006;33(2):176-95. doi:10.1007/s11414-006-9009-3
24. Klein AR, Cnaan, R. A., & Whitecraft, J. Significance of peer social support with dually diagnosed clients: Findings from a pilot study. Research on Social Work Practice. 1998;8(5):529-551.
25. Davison KP, Pennebaker JW, Dickerson SS. Who talks? The social psychology of illness support groups. Am Psychol. Feb 2000;55(2):205-17.
26. Wilson ME, Flanagan, S., & Rynders, C. The FRIENDS program: A peer support group model for individuals with a psychiatric disability. Psychiatric Rehabilitation Journal. 1999;22(3):239.
27. Yanos PT, Primavera LH, Knight EL. Consumer-run service participation, recovery of social functioning, and the mediating role of psychological factors. Psychiatr Serv. Apr 2001;52(4):493-500. doi:10.1176/appi.ps.52.4.493
28. Wiltsey Stirman S, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implement Sci. Jun 6 2019;14(1):58. doi:10.1186/s13012-019-0898-y
29. Kirk MA, Moore JE, Wiltsey Stirman S, Birken SA. Towards a comprehensive model for understanding adaptations' impact: the model for adaptation design and impact (MADI). Implement Sci. Jul 20 2020;15(1):56. doi:10.1186/s13012-020-01021-y
30. Leung FH, Savithiri R. Spotlight on focus groups. Can Fam Physician. Feb 2009;55(2):218-9.
31. Tanya de Sousa AA MC, Jhenelle Marson, Ed Prestera, and Katherine Rush, Abt Associates. . The 2022 Annual Homelessness Assessment Report (AHAR) to Congress In: The U.S. Department of Housing and Urban Development. 2022;(ed2022)
32. Susser E, Valencia E, Conover S, Felix A, Tsai WY, Wyatt RJ. Preventing recurrent homelessness among mentally ill men: a "critical time" intervention after discharge from a shelter. Am J Public Health. Feb 1997;87(2):256-62. doi:10.2105/ajph.87.2.256
33. Chinman M, George P, Dougherty RH, et al. Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatr Serv. Apr 1 2014;65(4):429-41. doi:10.1176/appi.ps.201300244
34. Chinman M, Shoai R, Cohen A. Using organizational change strategies to guide peer support technician implementation in the Veterans Administration. Psychiatr Rehabil J. Spring 2010;33(4):269-77. doi:10.2975/33.4.2010.269.277
35. Development HaU. Definition of Chronic Homelessness.
36. Eisen SV, Normand SL, Belanger AJ, Spiro A, 3rd, Esch D. The Revised Behavior and Symptom Identification Scale (BASIS-R): reliability and validity. Med Care. Dec 2004;42(12):1230-41. doi:10.1097/00005650-200412000-00010
37. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. Sep 18 2013;13:117. doi:10.1186/1471-2288-13-117
38. Bryant A, Charmaz K. The SAGE Handbook of Grounded Theory: Paperback Edition. SAGE Publications; 2010.
39. Sandelowski M. Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-method studies. Res Nurs Health. Jun 2000;23(3):246-55. doi:10.1002/1098-240x(200006)23:3<246::aid-nur9>3.0.co;2-h
40. Druss BG. Addressing the COVID-19 Pandemic in Populations With Serious Mental Illness. JAMA Psychiatry. Sep 1 2020;77(9):891-892. doi:10.1001/jamapsychiatry.2020.0894
41. Smith K, Ostinelli E, Macdonald O, Cipriani A. COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians. JMIR Ment Health. Aug 28 2020;7(8):e21108. doi:10.2196/21108
42. Maulik PK, Thornicroft G, Saxena S. Roadmap to strengthen global mental health systems to tackle the impact of the COVID-19 pandemic. Int J Ment Health Syst. 2020;14:57. doi:10.1186/s13033-020-00393-4
43. Han RH, Schmidt MN, Waits WM, Bell AKC, Miller TL. Planning for Mental Health Needs During COVID-19. Curr Psychiatry Rep. Oct 8 2020;22(12):66. doi:10.1007/s11920-020-01189-6
44. Jurcik T, Jarvis GE, Zeleskov Doric J, et al. Adapting mental health services to the COVID-19 pandemic: Reflections from professionals in four countries. Counselling Psychology Quarterly. 2021;34(3-4):649-675. doi:10.1080/09515070.2020.1785846
45. Pagano A, Hosakote S, Kapiteni K, Straus ER, Wong J, Guydish JR. Impacts of COVID-19 on residential treatment programs for substance use disorder. J Subst Abuse Treat. Apr 2021;123:108255. doi:10.1016/j.jsat.2020.108255
46. Clair K, Ijadi-Maghsoodi R, Nazinyan M, Gabrielian S, Kalofonos I. Veteran Perspectives on Adaptations to a VA Residential Rehabilitation Program for Substance Use Disorders During the Novel Coronavirus Pandemic. Community Ment Health J. Jul 2021;57(5):801-807. doi:10.1007/s10597-021-00810-z
47. Kim B, Petrakis BA, Sliwinski SK, McInnes DK, Gifford AL, Smelson DA. Staff and Veteran Perspectives on Residential Treatment Programs' Responses to COVID-19: A Qualitative Study Guided by the WHO's After Action Review Framework. Community Ment Health J. Apr 2023;59(3):600-608. doi:10.1007/s10597-022-01038-1
48. Guthrie-Gower S, Wilson-Menzfeld G. Ex-military personnel's experiences of loneliness and social isolation from discharge, through transition, to the present day. PLoS One. 2022;17(6):e0269678. doi:10.1371/journal.pone.0269678
49. Hystad P, Carpiano RM. Sense of community-belonging and health-behaviour change in Canada. J Epidemiol Community Health. Mar 2012;66(3):277-83. doi:10.1136/jech.2009.103556
50. Best D, Irving J, Collinson B, Andersson C, Edwards M. Recovery Networks and Community Connections: Identifying Connection Needs and Community Linkage Opportunities in Early Recovery Populations. Alcoholism Treatment Quarterly. 12/27 2016;35:1-14. doi:10.1080/07347324.2016.1256718
51. Best D, Musgrove A, Hall L. The bridge between social identity and community capital on the path to recovery and desistance. Probation Journal. 2018;65(4):394-406. doi:10.1177/0264550518790677
52. Tucker JS, D'Amico EJ, Pedersen ER, Garvey R, Rodriguez A, Klein DJ. Behavioral Health and Service Usage During the COVID-19 Pandemic Among Emerging Adults Currently or Recently Experiencing Homelessness. J Adolesc Health. Oct 2020;67(4):603-605. doi:10.1016/j.jadohealth.2020.07.013
53. Dunlop A, Lokuge B, Masters D, et al. Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic. Harm Reduct J. May 6 2020;17(1):26. doi:10.1186/s12954-020-00370-7
54. Aragona M, Barbato A, Cavani A, Costanzo G, Mirisola C. Negative impacts of COVID-19 lockdown on mental health service access and follow-up adherence for immigrants and individuals in socio-economic difficulties. Public Health. Sep 2020;186:52-56. doi:10.1016/j.puhe.2020.06.055
55. Cawley C, Kanzaria HK, Zevin B, Doran KM, Kushel M, Raven MC. Mortality Among People Experiencing Homelessness in San Francisco During the COVID-19 Pandemic. JAMA Netw Open. Mar 1 2022;5(3):e221870. doi:10.1001/jamanetworkopen.2022.1870
56. Conway B, Truong D, Wuerth K. COVID-19 in homeless populations: Unique challenges and opportunities. Future Virology. 06/26 2020;15doi:10.2217/fvl-2020-0156
57. Ahmed F, Ahmed N, Pissarides C, Stiglitz J. Why inequality could spread COVID-19. Lancet Public Health. May 2020;5(5):e240. doi:10.1016/s2468-2667(20)30085-2
58. Pirisi A. Low health literacy prevents equal access to care. Lancet. Nov 25 2000;356(9244):1828. doi:10.1016/s0140-6736(05)73297-9
59. Douglas PK, Douglas DB, Harrigan DC, Douglas KM. Preparing for pandemic influenza and its aftermath: mental health issues considered. Int J Emerg Ment Health. Summer 2009;11(3):137-44.
60. Huremović D. Psychiatry of pandemics: A mental health response to infection outbreak (Ed.). Springer International Publishing. 2019;doi:https://doi.org/10.1007/978-3-030-15346-5
61. Zhou X, Snoswell CL, Harding LE, et al. The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemed J E Health. Apr 2020;26(4):377-379. doi:10.1089/tmj.2020.0068
62. Bureau USC. QuickFacts, Springfield City, Massachusetts. https://www.census.gov/quickfacts/fact/table/springfieldcitymassachusetts/PST045222
63. Centers for Disease Control and Prevention/ Agency for Toxic Substances and Disease Registry/ Geospatial Research A, and Services Program. CDC/ATSDR Social Vulnerability Index Database Massachusetts. https://www.atsdr.cdc.gov/placeandhealth/svi/data_documentation_download.html
64. Padgett DK, Henwood B, Abrams C, Davis A. Engagement and retention in services among formerly homeless adults with co-occurring mental illness and substance abuse: voices from the margins. Psychiatr Rehabil J. Winter 2008;31(3):226-33. doi:10.2975/31.3.2008.226.233
65. Horsfall J, Cleary M, Hunt GE, Walter G. Psychosocial treatments for people with co-occurring severe mental illnesses and substance use disorders (dual diagnosis): a review of empirical evidence. Harv Rev Psychiatry. 2009;17(1):24-34. doi:10.1080/10673220902724599
66. Nunez A, Sreeganga SD, Ramaprasad A. Access to Healthcare during COVID-19. Int J Environ Res Public Health. Mar 14 2021;18(6)doi:10.3390/ijerph18062980
67. Chen KL, Brozen M, Rollman JE, et al. How is the COVID-19 pandemic shaping transportation access to health care? Transp Res Interdiscip Perspect. Jun 2021;10:100338. doi:10.1016/j.trip.2021.100338
68. Byrne A, Barber R, Lim C. Impact of the COVID‐19 pandemic – a mental health service perspective. Progress in Neurology and Psychiatry. 2021;25